TITLE: Medicare Drug Reimbursements: A Broken System for Patients and Taxpayers

CIS-NO: 2002-H361-10  
SOURCE: Committee on Energy and Commerce. House  
DOC-TYPE: Hearing Retrieve the full text of testimony  
DATE: Sept. 21, 2001  
LENGTH: v+398 p. il.  
CONG-SESS: 107-1  
ITEM-NO: 1019-A-01; 1019-B-01  
SUDOC: Y4.C73/8:107-65  
MC-ENTRY-NO: 2002-9088  
 
GPO-STOCK-NO: 552-070-27777-3.

SUMMARY:
Committee Serial No. 107-65. Hearing before the Subcom on Health and the Subcom on Oversight and Investigations to examine Medicare Part B reimbursement system for current prescription drug coverage, which is limited principally to drugs administered incident to a physician's treatment or in conjunction with covered durable medical equipment.
 
Under the current system, Medicare bases the appropriate reimbursement price for a covered prescription drug on an average wholesale price (AWP) determined by manufacturers and listed in an industry trade publication. Providers who administer the covered drugs are reimbursed at prices equal to the AWP minus five percent. Medicare Part B covers 80% of the reimbursement and Medicare beneficiaries, in most cases, are required to pay the remaining 20% as a co-payment.
 
Addresses allegations that drug manufacturers artificially inflate AWPs, resulting in overcharges to the Medicare program and to Medicare beneficiaries.
 
Supplementary material (p. 13-17, 143-398) includes a report, correspondence, graphs, tables, exhibits, and:
   -- Nicola, Thomas J. (CRS) "Regulatory and Legislative History of Medicare Drug Reimbursement Based on Average Wholesale Price" Aug. 31, 2001 (p. 369-376).

CONTENT-NOTATION: Medicare prescription drug reimbursement policy

DESCRIPTORS:  
   SUBCOM ON HEALTH, ENERGY AND COMMERCE. HOUSE;  GOVERNMENT INVESTIGATIONS; MEDICARE; DRUGS; MEDICAL REGULATION; FRAUD; HEALTH FACILITIES AND SERVICES; MEDICAL SUPPLIES AND EQUIPMENT; PHYSICIANS; MEDICAL ECONOMICS; STATISTICAL DATA: HEALTH AND VITAL STATISTICS

02-H361-10 TESTIMONY NO: 1     Sept. 21, 2001 p. 30-82, 290-307
 
WITNESSES (and witness notations):
   SCANLON, WILLIAM J. (Director, Health Care Issues, GAO)
   GROB, GEORGE F. (Deputy Inspector General, Evaluation and Inspections, Office of Inspector General (OIG), HHS)
   BENTLEY, ZACHARY T. (Business Manager, Ven-A-Care of the Florida Keys, Inc)
 
STATEMENTS AND DISCUSSION:
   Criticism of Medicare Part B prescription drug reimbursement policy, focusing on objections to use of AWP as a basis for calculations; recommendations to revise Medicare drug reimbursement policy.
   Explanation of HHS OIG findings that Medicare drug reimbursement system results in excessive charges to the program and to program beneficiaries; nature of fraud schemes involving Medicare prescription drug pricing.
 
INSERTION:
   -- HHS OIG, "Infusion Therapy Services Provided in Skilled Nursing Facilities" final audit report, Dec. 13, 1999 (p. 290-304).
 
CONTENT NOTATION:
   Medicare prescription drug reimbursement policy
 
TESTIMONY DESCRIPTORS:
   GENERAL ACCOUNTING OFFICE; OFFICE OF THE INSPECTOR GENERAL, HHS; HOSPITALS AND NURSING HOMES
 
 
02-H361-10 TESTIMONY NO: 2     Sept. 21, 2001 p. 82-101
 
WITNESSES (and witness notations):
   SCULLY, THOMAS A. (Administrator, Centers for Medicare and Medicaid Services)
 
STATEMENT AND DISCUSSION:
   Overview of Medicare prescription drug coverage and reimbursement policy.
 
CONTENT NOTATION:
   Medicare prescription drug reimbursement policy
 
TESTIMONY DESCRIPTORS:
   CENTERS FOR MEDICARE AND MEDICAID SERVICES
 
 
02-H361-10 TESTIMONY NO: 3     Sept. 21, 2001 p. 101-143
 
WITNESSES (and witness notations):
   NORTON, LARRY (Dr.) (Head, Division of Solid Tumor Oncology, Memorial Sloan-Kettering Cancer Center; representing American Society of Clinical Oncology)
   MARTYN, KEVIN (Executive Director, Care for Life)
   CONNAUGHTON, THOMAS A. (President, American Association of Homecare)
   LAMPHERE, JOANN (Senior Manager, Health Care Finance Practice, Lewin Group)
   EMANUEL, EZEKIEL (Chief, Clinical Bioethics Department, Warren G. Magnuson Clinical Center, NIH)
 
STATEMENTS AND DISCUSSION:
   Recommendations regarding Medicare Part B prescription drug payment system, including suggestions to restructure payments for chemotherapy drugs and services; importance of adequate Medicare drug reimbursement policies to certain providers of home health services, including infusion and respiratory care services.
   Findings of study regarding the use of chemotherapy to treat dying cancer patients receiving end-of-life care (related tables, p. 124-126).
 
CONTENT NOTATION:
   Medicare prescription drug reimbursement policy
 
TESTIMONY DESCRIPTORS:
   AMERICAN SOCIETY OF CLINICAL ONCOLOGY; CARE FOR LIFE; AMERICAN ASSOCIATION OF HOMECARE; LEWIN GROUP; NATIONAL INSTITUTES OF HEALTH; RESPIRATORY DISEASES; DEATH AND DYING; HOME HEALTH SERVICES; CANCER

LOAD-DATE: February 3, 2003